NPI 1124157185

Kermit C Sullivan, ATC

Practitioner Athletic Trainer Nampa, ID

Practice location

Address: 1303 E Greenhurst Rd, Nampa, ID 83686-7216
Phone: (208) 468-7820
Mailing address: 231 N Turtle Dove Way, Nampa, ID 83651-8363

Registered specialties

Athletic Trainer Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 2255A2300X Licence AT-182 (ID)

Other Specialist/Technologist providers in Idaho →

Registry record

NPI: 1124157185
Entity type: Individual
Sex (as registered): Male
NPI issued: 5 Mar 2007
Record last updated: 8 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.